Laryngeal Cancer Treatment (PDQ®)

As a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, a core part of our mission is to educate patients and the community about cancer. The following summary is trusted information from the NCI.

General Information About Laryngeal Cancer

Laryngeal cancer is a disease in which malignant (cancer) cells
form in the tissues of the larynx.

The larynx is a part of the throat, between the base of the tongue and the trachea. The larynx contains the vocal
cords, which vibrate and make sound when air is directed against
them. The sound echoes through the pharynx, mouth, and nose to make a person's
voice.

Use of tobacco products and drinking too much alcohol can affect the risk
of laryngeal cancer.

Anything that increases your risk of getting a disease is called
a risk factor. Having a risk factor does not mean that you will
get cancer; not having risk factors doesn't mean that you will
not get cancer. Talk with your doctor if you think you may be at risk.

Signs and symptoms of laryngeal cancer include a sore throat and
ear pain.

These and other signs and symptoms may be caused by laryngeal cancer or by
other conditions. Check with your doctor if you have any of the following:

A sore throat or cough that does not go away.

Trouble or pain when swallowing.

Ear pain.

A lump in the neck or throat.

A change or hoarseness in the voice.

Tests that examine the throat and neck are used to help detect
(find), diagnose, and stage laryngeal cancer.

The following tests and procedures may be used:

Physical exam of the throat and neck: An exam to check the throat and neck for abnormal areas. The doctor will feel the inside of the mouth with a gloved finger and examine the mouth and throat with a small
long-handled mirror and light. This will include checking the insides of the cheeks and lips; the gums; the back, roof, and floor of the mouth; the top, bottom, and sides of the tongue; and the throat. The neck will be felt for swollen lymph nodes. A history of the patient's health habits and past illnesses and medical treatments will also be taken.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The sample of tissue may be removed during one of the following procedures:

Laryngoscopy: A
procedure to look at the larynx (voice box) for abnormal areas. A mirror or
a laryngoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the mouth to see the larynx. A special tool on the laryngoscope may be used to remove samples of tissue.

Endoscopy: A
procedure to look at organs and tissues inside the body, such as the throat, esophagus, and trachea to check for abnormal areas. An endoscope (a thin, lighted tube with a light and a lens for viewing) is inserted through an opening in the body, such as the mouth. A special tool on the endoscope may be used to remove samples of tissue.

CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

PET scan (positron emission tomography scan): A procedure to find malignanttumor cells in the body. A small amount of radioactiveglucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metalliccompound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

Smoking tobacco and drinking alcohol decrease the effectiveness of
treatment for laryngeal cancer. Patients with laryngeal cancer who continue to smoke and drink are less likely to be cured and more likely to develop a second tumor. After treatment for laryngeal cancer,
frequent and careful follow-up is important.

Stages of Laryngeal Cancer

After laryngeal cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the larynx or to other parts of the
body.

The process used to find out if cancer has spread within the
larynx or to other parts of the body
is called staging. The information
gathered from the staging process determines the stage of the disease. It is important to know the
stage of the disease in order to plan treatment. The results of some of the tests used to diagnoselaryngeal cancer are often also used to stage the disease.

There are three ways that cancer spreads in the body.

Tissue. The cancer spreads from where it began by growing into nearby areas.

Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.

Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.

Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if laryngeal cancer spreads to the lung, the cancer cells in the lung are actually laryngeal cancer cells. The disease is metastatic laryngeal cancer, not lung cancer.

Stage III

cancer is in the larynx only and the vocal cords cannot move, and/or cancer is in tissues next to the larynx. Cancer may have spread to one lymph node on the same side of
the neck as the original tumor and the lymph node is 3
centimeters or smaller; or

cancer is in one area of the supraglottis and in one lymph node on the same side of
the neck as the original tumor; the lymph node is 3
centimeters or smaller and the
vocal cords can move
normally; or

cancer is in more than one area of the supraglottis or surrounding tissues and in one lymph node on the same side of
the neck as the original tumor; the lymph node is 3
centimeters or smaller.

cancer is in the larynx only and the vocal cords cannot move, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of
the neck as the original tumor and the lymph node is 3
centimeters or smaller; or

cancer
is in one or both vocal cords and in one lymph node on the same side of
the neck as the original tumor; the lymph node is 3
centimeters or smaller and the vocal cords can move normally; or

cancer has spread to the supraglottis and/or the
subglottis and/or the vocal cords cannot move normally. Cancer has also spread to one lymph node on the same side of
the neck as the original tumor and the lymph node is 3
centimeters or smaller.

cancer is in the subglottis and in one lymph node on the same side of
the neck as the original tumor; the lymph node is 3
centimeters or smaller; or

cancer has spread to one or both vocal cords, which may
not move normally. Cancer has also spread to one lymph node on the same side of
the neck as the original tumor and the lymph node is 3
centimeters or smaller.

cancer has spread to one lymph node on the same side of the neck as the original tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters, or has spread to more than one lymph node anywhere in the neck with none larger than 6 centimeters. Cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. The vocal cords may not move normally.

cancer has spread to the space in front of the spinal column, surrounds the carotid artery, or has spread to parts of the chest. Cancer may have spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size; or

cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest. The vocal cords may not move normally.

Treatment Option Overview

There are different types of treatment for patients with
laryngeal cancer.

Different types of treatment are available for patients with
laryngeal cancer. Some treatments are standard (the currently
used treatment), and some are being tested in clinical trials. A treatment
clinical trial is a research study meant to help improve current treatments or
obtain information on new treatments for patients with cancer. When clinical
trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Radiation therapy may work better in patients who have
stopped smoking before beginning treatment. External radiation therapy to the
thyroid or the
pituitary gland may change the way
the thyroid gland works. The doctor may test the thyroid gland before
and after therapy to make sure it is working properly.

Even if the doctor removes all the cancer that can be seen at the
time of the surgery, some patients may be given chemotherapy or radiation
therapy after surgery to kill any cancer cells that are left. Treatment given
after the surgery, to lower the risk that the cancer will come back, is called
adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical
trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk cancer will recur (come back). The drug isotretinoin is being studied to prevent the development of a second cancer in patients who have had cancer of the head or neck.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I laryngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II laryngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

A clinical trial of chemotherapy, radiosensitizers, or radiation therapy.

A clinical trial of chemoprevention.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III laryngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

A clinical trial of chemotherapy, radiosensitizers, or radiation
therapy.

A clinical trial of chemoprevention.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV laryngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent laryngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.